Lack of patient records leads to $14,040 Medicaid recoupment from healthcare provider

Topic: Health Law, Decided by: Judge Walker 
Docket Number: 2220233 , Decision Date: September 21, 2022 
Attachment: Click here to download the decision. 

The Department of Community Health sought to recoup $14,040.00 paid to a healthcare provider for services it delivered through Medicaid.  The Court affirmed the Department’s decision, finding that the provider did not have sufficient patient-treatment records that would justify the billed Medicaid costs.  Although the provider argued the COVID-19 pandemic prevented it from obtaining the necessary records, the Court rejected that reasoning, noting that it “strains credulity” to believe the provider could not contact a patient’s physician to get the necessary Plans of Treatment that would show which services were received.

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